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Name....Tina 8iemers No ................................. <br />.............................................. Vidor �rne�m�yer <br />Addred.WRI4..t? mcl..;MlAnd...010... Mrs.... County of..... a 1 ....................... <br />Changesof Address...; ................................................................................................................. <br />...............................................................................................:.................................................................. <br />Original Grant $.....�,�. QQ ........... Date ........ ,puna-- ...................19.30 <br />. ... <br />Amount of <br />Grant <br />Date <br />STATUS Amount of <br />(Mod., sump., Cana., Rao.) Grant <br />Date <br />STATUS <br />(Mod., Sump., Cana., Roo.) <br />.......................................................... ,................................... He.il....bmdemaer........ ... <br />nature of Pay" Director of Assiatanae and Child We e <br />